Table 1.

Summary of some disease modifying drugs used in multiple sclerosis.

Drug	Approved indication(s)	Possible mechanism of action	Some common adverse effects	Route(s)	References
IFN-β-1a	RRMS, CIS	Inhibition of CD4+ T-cells and enhancement of CD8+ T-cells.	Hypersensitivity reaction, hepatotoxicity, haematologic disorders, and injection site reactions.	Subcut./IM	[30, 31]
IFN-β-1b	RRMS, Progressive MS	The same as above.	Same as above.	The same as above.	[30, 31]
Glatiramer acetate	RRMS, CIS	Downregulates the expression of autoreactive T-cells.	Injection site reaction, mood disturbance, and hypersensitivity reaction.	Subcut.	[31, 32]
Natalizumab	RRMS, Severe Remitting MS	Acts on α4 integrins resulting in inhibition of leukocyte migration into the CNS.	Increased risk of PML, hepatotoxicity, and hypersensitivity reaction.	IV	[33, 34]
Fingolimod	RRMS after IFN	Modulates sphingosine-1-phosphate receptors preventing the egress of lymphocytes from lymph nodes.	Hepatotoxicity, atrioventricular block, increased risk of malignancy, and mood disturbance.	Orally	[35–37]
Dimethyl fumarate	Relapsing MS	Activate nuclear factors resulting in anti-inflammatory, antioxidant, and neuroprotective properties.	Increase hepatic enzymes, gastrointestinal upset, and lymphopaenia.	Orally	[38, 39]
Mitoxantrone	Aggressive MS, SPMS	Inhibits B-cell, T-cell, and macrophage proliferation.	Cardiotoxicity, Leukopaenia,	IV	[39]

(Im: intramuscularly; iv: intravenously; subcut.: subcutaneously).